From the Guidelines
Kaposi's sarcoma treatment should prioritize antiretroviral therapy (ART) as the primary approach, especially for patients with HIV-associated disease, as it can lead to regression of lesions through immune reconstitution. The management of AIDS-related Kaposi sarcoma depends on the location and extent of the disease, with patients having limited cutaneous disease that is asymptomatic and cosmetically acceptable to the patient potentially being treated with ART alone 1. For those with symptomatic and/or cosmetically unacceptable limited cutaneous disease, treatment with ART and minimally invasive therapies with the least toxicity possible is recommended, including options like topical treatment, intralesional chemotherapy, radiation, and local excision.
Key considerations in the treatment of Kaposi's sarcoma include:
- The importance of early involvement of a lymphedema specialist, as lymphedema often complicates Kaposi sarcoma 1.
- The use of systemic therapy for advanced cutaneous, oral, visceral, or nodal AIDS-related Kaposi sarcoma, with preferred initial treatment being ART with clinical trial or systemic therapy, and radiation as an alternative for those not eligible for clinical trial or systemic therapy 1.
- A typical systemic therapy sequence for relapsed/refractory disease, which includes first-line liposomal doxorubicin, followed by second-line paclitaxel, and then pomalidomide in the third line of treatment 1.
- The avoidance of glucocorticoids in patients with active or prior Kaposi sarcoma due to the potential for significant flares or relapses, limiting their use to life-threatening conditions where they are otherwise indicated 1.
Overall, the goal of therapy for patients with Kaposi's sarcoma is to control symptoms, mitigate end-organ damage, and achieve long-term disease control, with complete remissions being rare but possible in some cases 1. Regular follow-up is crucial to monitor response to treatment and detect new lesions early, as individual Kaposi sarcoma lesions may be distinct clones that can arise due to common risk factors such as immunosuppression and persistent HHV-8 infection 1.
From the Research
Definition and Forms of Kaposi's Sarcoma
- Kaposi's sarcoma (KS) is a malignancy associated with Kaposi's sarcoma-associated herpesvirus (KSHV), primarily affecting immunocompromised individuals, such as those with HIV or those receiving immunosuppressive treatments 2.
- KS manifests in different forms, including classic, endemic, epidemic, iatrogenic, and in men having sex with men, each with distinct clinical features depending on immune status and geographic area of origin 2, 3.
Diagnosis and Staging
- The diagnosis of KS is primarily based on clinical features and confirmation by histology with immunohistochemistry 3.
- Staging of KS involves assessing disease extension, including cutaneous distribution and severity, mucosal, nodal, and visceral involvement 2, 3.
Treatment Strategies
- Treatment strategies for KS include restoring immunity in immunocompromised patients, alongside conventional local therapies, and chemotherapy options like liposomal doxorubicin and paclitaxel for aggressive and extensive forms 2, 3.
- Promising emerging therapies, including immunomodulatory agents, antiangiogenic therapies, and checkpoint inhibitors, are also being explored 2.
- Radiation therapy is a valuable means of pain relief, bleeding control, and edema palliation, and is also an effective treatment modality for local control of skin and mucosal lesions in KS 4.
Management of AIDS-Related Kaposi's Sarcoma
- The advent of highly active antiretroviral therapy (HAART) has led to a substantial reduction in the prevalence, morbidity, and mortality associated with AIDS-related KS 5, 6.
- Concomitant advances in chemotherapy and supportive-care protocols have allowed for KS to be managed more effectively in comparison with the pre-HAART era 6.
- Developments in our understanding of the pathogenesis of KS have identified several molecular targets that can potentially provide new therapeutic strategies 5, 6.